Emergency responders frequently transport people with no serious injuries to costly high-level trauma centers, triggering hundreds of millions in wasted health care spending each year, according to a new study led by Portland researcher Craig Newgard.

Newgard, an Oregon Health & Science University associate professor and emergency department doctor, led a group of researchers who tracked costs for more than 300,000 patients transported by ambulance in seven regions including greater Portland.

In an era of growing concern over health care spending, the study puts the biggest price tag yet on waste in a type of care that consumes 10 percent of the nation's medical expenditures. Trauma care represents the second biggest driver of costs in the U.S. health care system, after heart disease.

The study, which appeared in the journal Health Affairs, also showed why costs are so difficult to control. "There is some waste in the system," said Newgard, who worked as an EMT while in college. "(But) there would be some consequences to getting rid of all that waste."

Hospitals with comprehensive emergency rooms earn designation as a regional Level 1 or Level 2 trauma center if they meet federal requirements, as Legacy Emanuel and OHSU do in Oregon. Such premium care, the envy of the world, has saved countless lives. But these hospitals also have to charge more to support specially equipped facilities and specialist-heavy payrolls.

The researchers found that treating injuries cost nearly twice as much at Level 1 trauma hospitals as compared to non-trauma hospitals after being categorized by injury seriousness.

In about one-third of cases studied, patients sent to trauma centers weren't considered high risk under the guidelines used by responders, and therefore derived no benefit from the higher level of service.

In other words, money is being wasted: $136.7 million annually in the regions studied, which included Seattle, Sacramento, San Francisco, Santa Clara, Salt Lake City and Denver.

An earlier study found the national tally of similar ambulance transport decisions exceeds $500 million a year, and Newgard said based on the new research -- which focused only on seven regions --the national price tag is probably far more.

But restricting trips to trauma centers would come with a cost of its own. That's because paramedics frequently take patients to the nearest hospital or the one of their choice.

"All these issues are more complicated than they seem on the surface," Newgard said.

Randy Lauer, general manager of the local ambulance provider, American Medical Response, is not surprised by the study's findings. Emergency medical care systems tend to be conservative, with little tolerance for error, and that's why people often are transported to trauma centers when they don't need it.

"First and foremost, what the patient wants to do drives what we do," he said.

Lauer said two emergency response pilot programs will tackle unnecessary emergency costs locally in the coming year. Rather than necessarily transporting injured people to a hospital emergency department, emergency response teams will give them other options, ranging from transport to a local clinic or letting them stay at home with an appointment for care the next day.

"We know that we can't sustain the costs of the health care system. Somethings gotta give," he said. "With health care reform a lot of that is going to change."